2006 VOTING PROCESS ACCESSIBILITY QUESTIONNAIRE Thank you for participating! Please provide as much information as you can. Date: __________________ Your name: _____________________________________ Observer contact information (your personal information will not be released without your express permission): _____________________________________________________________________________ _____________________________________________________________________________ Voting place name:___________________________________________________________ Voting place address:________________________________________________________ Voting place city, state and zip code:_______________________________________ Voting place number (there may be several per voting place): ________________ Observer Type: (Please check all that apply) Election worker ___ Voter with a disability ___ Other Voter___ Public Observer ___ Date & Time You Observed: ______________ How Long You Observed: ____________ ***************************************************************************** PARKING OR DROPPING OFF A PASSENGER 1. Are there accessible parking spaces? Yes______ No______ Don’t Know______ 2. Is there a clearly marked accessible passenger drop-off area near the entrance? Yes______ No______ Don’t Know______ 3. Are there spaces for vans as well as passenger cars? Yes______ No______ Don’t Know______ 4. Are the parking spaces readily on the route to the accessible entrance? Yes______ No______ Don’t Know______ GETTING INTO THE BUILDING 5. Is there an accessible route (non-gravel, curb cut, bump free, step free, no steep slope) from accessible parking spaces and drop-off areas to the accessible entrance(s) of the building? Yes______ No______ Don’t Know______ 5a. If no, please elaborate on how the route was not accessible: ______________________ ______________________________________________________________________________ 6. Is there at least one accessible entrance that is clearly marked as accessible and is unlocked and easily opened by someone with a disability? Yes______ No______ Don’t Know______ 6a. If not the main entrance, is it clearly marked and in sight of the main entrance, or are there clear directions for getting there? Yes______ No______ Don’t Know______ GETTING TO THE VOTING AREA 7. Is there an accessible route inside the polling place between the accessible entrance and the voting area (clear travel space, no barriers, steps, etc.)? Yes______ No______ Don’t Know______ 7a. If no, please elaborate:_______________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ TYPE OF ACCESSIBLE VOTING EQUIPMENT USED IN THE POLLING PLACE: 8. Is there at least one voting system identified as accessible for individuals with disabilities? Yes______ No______ Don’t Know______ 9. Which access features does the voting system have? Please mark all that apply. a. Audio ballot (voter listens to the ballot and marks it by using buttons or keys) Yes ___No ___ Don’t Know______ b. Large print ballot (voter uses enlarged text to see and mark ballot) Yes ___No ___ Don’t Know______ c. Button or switch control (voter uses buttons, knobs, or switches to mark ballot) Yes ___No ___ Don’t Know______ d. If other, please describe: ______________________________________________________ 10. What kind of voting equipment is provided to meet accessibility requirements? If possible, please include model and manufacturer information: ________________________________________________________________________________ ________________________________________________________________________________ 10a. Comments about the above voting system: ___________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 11. Was the accessible voting system set up and ready for use at poll-opening? Yes______ No______ Don’t Know______ 12. If problems occurred with the accessible voting system, were they resolved in a timely manner so that the system worked? Yes______ No______ Don’t Know______ 12a. Please describe:_____________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 13. Does the accessible voting system offer enough privacy protection from eavesdroppers and other people seeing the accessible ballots? Yes______ No______ Don’t Know______ 14. Does the accessible voting system produce a paper ballot or otherwise incorporate a voter-verifiable paper record? Yes______ No______ Don’t Know______ 14a. If so, please describe how a person with a disability is able to verify the paper ballot or paper record: _________________________________________________________________ ________________________________________________________________________________ VOTING 15. Are photo IDs required for identification? Yes______ No______ Don’t Know______ 15a. Additional comments:________________________________________________________ ________________________________________________________________________________ 16. Is adequate instruction available to allow those with disabilities to vote independently? Yes______ No______ Don’t Know______ 17. Is the accessible voting system portable (i.e. could it be placed in a voter’s lap or on a lap tray)? Yes______ No______ Don’t Know______ 17a. Is the voting system adjustable (can height be changed or screen tilted)? Yes______ No______ Don’t Know______ 18. Did you observe voters having difficulty using any of the features of the accessible voting system (e.g. the audio ballot, large print display, switches etc.)? Yes______ No______ Don’t Know______ Specific Comments:_______________________________________________________________ ________________________________________________________________________________ 19. Are all voters informed that they may opt to use the accessible system? Yes______ No______ Don’t Know______ 20. Do the poll workers seem knowledgeable about the accessible voting system? Yes______ Somewhat ______ Not Very ______ Not at all ______ Don’t Know______ 21. Are the poll workers respectful of the need for privacy while voting? Yes______ Somewhat ______ Not Very ______ Not at all ______ Don’t Know______ 22. Is confidentiality guaranteed for all voters, including those who request large print or audio ballots due to visual impairments, or those who have physical disabilities that make it difficult or impossible to handle a paper ballot? Yes______ No______ Don’t Know______ GENERAL 23. Did the polling place have seating areas to allow individuals with disabilities or elderly persons to sit down? Yes______ No______ Don’t Know______ 24. Did the polling place have signs and audible information informing people how to avoid standing in line? Yes______ No______ Don’t Know______ 25. Were voters with limited English proficiency provided appropriate sample ballots and instructions? Yes______ No______ Don’t Know______ 26. Did you encounter any difficulty entering the polling place or making observations? Yes______ No______ 26a. If yes, what were those difficulties? _____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 27. Any additional observations or comments: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ The Verified Voting Foundation thanks you for participating in this survey. We value your input and observations. The data from this study will be made public to help improve voting access for all. Please contact us at observer@verifiedvoting.org or at 415-487-2255 if you have any questions. To submit your data, you may email your responses to observer@verifiedvoting.org or fax a copy to 1-940-403-2255. If you prefer, you may enter the responses on our online form by emailing us to request the webform. A link will be sent to you by email so that you can enter your responses online. We also welcome your responses in hard copy at Verified Voting Foundation, 1550 Bryant Street, Suite 855, San Francisco, CA 94103-4879.